Salt Water Solution for Kids Hearing
First Published: Enews - May 2010
A Flinders team hope to prove something as simple as swimming in salt water chlorinated pools can reduce the alarming number of middle ear infections in children in remote Indigenous communities.
Supported by a $662,000 Federal Department of Health and Ageing grant, five staff and eight students from Flinders travel to the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands of northern South Australia and to the western Yalata community twice per year to assesses children for middle ear disease and related hearing loss.
The study is based on research led by audiologist Associate Professor Linnett Sanchez and ear, nose and throat surgeon Associate Professor Simon Carney which has shown about 70 per cent of school-age children living in Anangu communities in South Australia fail a screening hearing test.
30 per cent of these children have eardrum perforations (when injury to the ear or fluid accumulation from infection causes the thin membrane of the ear drum to rupture) compared to about 1 per cent of children living in Adelaide.
"We are seeing in Indigenous children persistent, significant hearing loss right through their educational years," Associate Professor Sanchez said. "This hearing loss can impact on children‘s education and social development, with serious consequences throughout life."
Last year the team tested 702 indigenous children from four communities which have swimming pools and seven which do not. Data are collected in autumn (at the end of the swimming season) and again in spring to examine whether there has been an effect on infections during the time the children have been unable to swim.
The large-scale study over three years hopes to replicate the positive findings of a small scale study by a Western Australian research team. The Flinders team believe any benefits established by the trial may be attributed to the combination of the irrigatory effect of the saline and the chemical effect of chlorination.
If findings show a benefit from swimming, it is expected that more remote communities will be able to better argue for government funding to install salt water pools.
Can Nutritional Supplements Alleviate Autism?
First Published: ENews - January 2010
Internationally renowned Flinders University psychologist Associate Professor Robyn Young is guiding a state-wide study to help determine whether nutritional supplements can benefit children with autism.
While it is estimated one in 160 Australian children have autism or a related developmental disorder, the cause of these disorders are unknown.
“We believe defective genes, combined with exposure to environmental insults, may result in a series of dysfunctional interactions between genes and nutrients,” Assoc Prof Young said.
International research has shown that the folate/methionine metabolic pathway is significantly different in many children with autism compared to non-autistic children. Folate (a B complex vitamin) and methionine (an amino acid) are taken in from the diet and required for many key biochemical reactions in the body including the maintenance of healthy DNA.
Working in conjunction with CSIRO Food and Nutritional Sciences, and University of South Australia researchers, Assoc Prof Young is leading the behavioural aspects of a study which seeks to investigate the way Australian children with autism metabolise methionine.
150 South Australian children (50 diagnosed with autistic disorder, 50 non-autistic siblings, and 50 with no family history of autism) will be screened as part of the study.
The researchers hope to establish whether children with autism have an abnormal folate/methionine pathway and whether these abnormalities correlate with behavioural patterns observed in the child.
They then hope to determine whether supplements to correct the blood profile, such as specific vitamins and nutrients, can improve autistic behaviour. This could potentially lead to better outcomes for individuals with autism through personalised nutrition based on an individual’s genetic makeup.
Novel Study Puts Nut Allergies To The Test
First Published: Investigator - July 2009
Updated: May 2011
Children with potentially fatal reactions to certain nuts can safely eat other nuts to free them of their nut allergy, a Flinders Medical Centre pilot study has shown.
In a major finding for children with nut allergies and their parents, the pilot study of 47 children showed that nuts which don’t cause an allergic reaction (non-allergic nuts) can safely be consumed by children with nut allergies.
Only 15-20 percent of children will naturally ‘grow out’ of nut allergy which can take years.
Children in the study were reviewed after only 6-12 months of non-allergic nut consumption.
About 25 percent of children went into remission and could safely eat both types of nuts – those which can cause an allergic reaction (allergic nuts) and non-allergic.
Flinders Medical Centre Paediatrician and study investigator Dr Billy Tao said children allergic to one or more nuts are usually told to avoid all nuts, including those which are not known to cause an allergic reaction.
‘People worry about unexpected accidents,’ he said. ‘However, it is quite possible that eating non-allergic nuts can be safe and improve tolerance to allergic nuts if done properly.’
Dr Tao said patients must undergo a supervised ‘nut challenge’ to determine which nuts are genuinely non-allergic and therefore safe to consume.
The study also showed that eating non-allergic nuts can improve psychological wellbeing and quality of life for nut-allergic children and their families. More than 90 percent of parents in the study reported improved psychological wellbeing about their children being able to eat different nuts at home without developing an allergic reaction.
All children who took part in the pilot study will continue to be reviewed over time to assess remission rates and psychological wellbeing of children and their families. Dr Tao expects more children in the study will go into remission after the first 6-12 month review period.
Dr Tao has now received funding from the Channel 7 Children’s Research Foundation begin a larger trial of 100 children to further demonstrate the benefits of non-allergic nuts for children with nut allergy, which is expected to be completed in late 2012.
‘We hope to duplicate the results of the pilot study, with a difference – this time we have a fully randomised control group for comparison,’ Dr Tao said.
‘If we can show that eating non-allergic nuts can help children develop tolerance to allergic nuts, it could be a very simple method for treating all types of nut allergies, and not just peanut allergies, which most current research projects are focused on.
‘Such a treatment would be inexpensive, does not require frequent trips to the doctor, and provides a more complete normalisation of life to children with nut allergies because they can eat any nut at any time following remission.’
Up to one percent of children will have a nut allergy. The majority of food allergy-related deaths are due to nut allergy.
Dr Tao is seeking to enrol another 57 children in the study. Parents who are interested in having their children participate can contact Dr Tao on 82109444 or after-hours on 82788353.
Echo Of A Tiny Heart
First Published: Investigator - February 2009
Many South Australians are going above and beyond the call of duty to help raise funds for an echocardiography machine for the Flinders Medical Centre Neonatal Unit so the hearts of critically ill and premature babies can be monitored at any time of the day or night.
Premature and often very sick, many of these tiny babies have abnormalities of the heart and circulation and breathing support, intravenous feeding and close monitoring is required.
Echocardiography allows medical staff to see the heart through a 3D ultrasound to assess how it is functioning, which is critical for diagnosing and addressing any issues that may arise.
3D technology incorporated in the machine will also give Flinders Neonatal consultants the opportunity to undertake research into premature baby health.
These research projects include: improving assessment of cardiac function and investigating the role of a range of drugs in the management of low blood pressure, cardiac output and perfusion of the brain.
Friendly Gut Bugs
First Published: Investigator - December 2008
A Flinders Medical Centre endocrinologist says eating foods that encourage ‘friendly gut bugs’ may be a key to preventing Type 1 diabetes.
‘Feeding young children foods rich in inulin and probiotics may actually help protect them against Type 1 diabetes, which is primarily a condition that affects children,’ Professor Nikolai Petrovsky, Director of Endocrinology said.
Inulin-rich foods include onion, garlic, chicory and artichoke. Probiotics can be found in yoghurts and probiotic drinks.
Professor Petrovsky’s comments follow research conducted at the University of Chicago and published in Nature journal which supports the ‘hygiene hypothesis’ that lack of exposure to specific organisms may actually predispose to allergies, asthma, and immune system disorders. In particular, the researchers were able to show that higher levels of ‘good bacteria’ in the gut could lower the incidence of type 1 diabetes.
‘The findings reflect a study I did on identical twins in Denmark during my PhD. We found that in about 40 percent of identical twins, one twin developed Type 1 diabetes while the other did not – which indicates there must be an environmental in addition to a genetic basis for autoimmune diabetes.’
‘It now appears that having good bacteria in the gut, which is an environmental factor because these bacteria are influenced by what you eat, can protect you against Type 1 diabetes even if you are genetically susceptible to it.’
Professor Petrovsky said ‘encouraging the good guys and shutting out the bad guys’ was the best strategy to good intestinal health.
‘That means not overloading children on carbohydrates and sugar which encourages the growth of bad bacteria, and feeding them inulin-rich foods and probiotics to encourage the good guys.’ Professor Petrovsky said the US research could go some way to explaining why the rate of immune diseases such as asthma and diabetes were on the increase in the western world.
‘As a society we’re becoming obsessed with cleanliness, but the research shows that some bacteria should be encouraged – as they can actually help pave the way to good health.’
He said keeping a child on breast milk for the first 6-9 months of their life was best, as breast milk would encourage the growth of the right type of protective bacteria in their gut. ‘And then when they’re weaned, their diet should contain a proportion of fibre and inulin-rich foods suppled by regular ‘top-up’ doses of probiotics from eating naturally-fermented foods such as yoghurt and cheese. So to the adage that ‘we are what we eat’ we need to add the adage ‘our health relies on the bacteria within us’.
What Is Whooping Cough?
First Published: Investigator - December 2008
Whooping cough, or pertussis, is a bacterial infection of the nose, throat and lungs caused by the bacteria Bordetella pertussis. The infection is so named because the long coughing spells, particularly in children, generally end with a ‘whooping’ noise as the child finally takes a massive gasping breath through an obstructed airway. Some children may vomit at the end of the episode. Coughing spells can last for several minutes and the sufferer can experience several bouts each hour. Children may have coughing bouts during sleep and the infection can last for many weeks. Older children and adults can have whooping cough without the classical ‘whooping’ sound. They have coughing spells lasting a minute or more, followed by several minutes of not coughing. The coughing spells seem to be caused by thick mucous in the lungs, which is difficult to cough up. Pertussis kills about 300,000 children worldwide each year. In Australia between 1993 and 2004, 18 children – mostly aged under 12 months old – died as a result of whooping cough. Immunisation against whooping cough can be very effective in protecting against the infection but the vaccine effectiveness falls with time.
Is whooping cough contagious?
Yes, whooping cough is very contagious. Around 70 – 100 percent of people living in the same house as someone with whooping cough will contract the infection (unless they have been immunised in the last 11 years or have had the infection). The infection is spread by ‘droplets’ that are coughed or sneezed out. These droplets can be breathed in or they can be carried to the nose by hands which come in contact with the droplets (eg through handling used tissues or by touching surfaces which have the droplets on them).
Who is most at risk?
Any one who is not protected (by recent immunisation or by having had the infection before) can get whooping cough, including older children and adults. Most people who get the infection in Australia are adults or young people over 11 years of age - even if they have been immunised as a baby. Babies are at most risk of having severe health problems from whooping cough. About 1 in 200 babies who get whooping cough before they are six months old will die from the infection.
Signs and symptoms of whooping cough
Whooping cough usually starts off like the average cold/cough, but develops into long bouts of repeated coughing fits after three to seven days. Children generally have many quick coughs in one spell and often ‘whoop’ at the end. Infants may turn blue, develop bulging eyes and tongue protrusion during episodes. Vomiting and weight loss are common. Very young babies may not cough, but instead, can stop breathing for a minute or longer many times per day. If they cough there might not be the whoop. Adults and older children may not whoop, but they will have persistent coughing spells and they may feel tired and generally unwell.
Diagnosis of whooping cough
Whooping cough may be suspected from symptoms, however laboratory tests are essential to confirm the diagnosis. At Flinders a test to detect the genetic material of B pertussis from a throat swab (PCR test) is performed, and this is the best diagnostic test. Blood tests to measure pertussis antibody are less reliable and are not recommended. X-rays may be taken to look for complicating pneumonia.
Whooping cough is generally treated with antibiotics. This will kill the bacteria but it does not stop the coughing which may go on for many weeks, unless the antibiotic is given very early in the illness. Young babies with whooping cough are often so ill that they need hospital treatment. Cough suppressing medicines may be helpful for adults. Part of the reason for coughing is that there is sticky mucous in the airways which needs to be coughed up. Always check with your doctor before giving a child a cough suppressing medicine. Children and adults exposed to whooping cough should seek advice from their doctor as they may require antibiotics to prevent infection occurring and further transmission of the disease.
What you can do
- Ensure your child is well hydrated and that they are eating enough
- Try feeding a young child immediately after a coughing spell. (Feeding often triggers a coughing spell if the child has not coughed recently, but soon after a coughing spell food and drink are generally well tolerated)
- Children who are coughing often will be tired and uncomfortable (coughing can cause tummy pain from overused muscles). Paracetamol may help with aching muscles.
Controlling the spread of whooping cough
Infants should be vaccinated against whooping cough at two, four and six months, followed by a booster dose at four years. A further single booster dose is now recommended in South Australia for the following groups:
- 13-14 year olds
- Parents planning pregnancy
- Parents of a newborn baby, as soon as possible after delivery
- Adults working with young children, especially child care and health care workers
- Adults aged 50 who have been vaccinated in the past.
This Health Talk article was compiled with the assistance of Professor David Gordon from Flinders Medical Centre; You’ve Got What? SA Department of Health; and Child and Youth Health (South Australia).
The Eyes Have It
First Published: Investigator - December 2008
The visual development of premature babies can be improved by enriching their diets with omega-3 oil, a medical scientist from the Child Nutrition Research Centre at Flinders Medical Centre has found.
Dr Lisa Smithers’ research work has seen her named Young Investigator of the Year for 2008.
More than 140 babies born at less than 33 weeks’ gestation took part in the trial, which involved them receiving milk rich in the omega-3 oil DHA, or the usual levels of DHA in milk.
Mothers who chose to breastfeed their infants ingested tuna oil capsules to increase human milk DHA.
Researchers then tested their visual development using a procedure devised by Lisa. Babies’ brain waves were monitored using sensors as they watched a television monitor with a series of decreasing striped patterns.
The test was carried out at two and four months of age, when babies’ visual systems are in a period of rapid development.
‘We know that DHA, an omega fat, is rich in the retina,’ Lisa said. She said DHA played an important role in converting light signals to electrical signals and then to the brain.
‘During pregnancy the developing baby gets DHA from their mothers, so babies born prematurely can miss out on this important omega fat.’
Lisa said babies in the study were provided with a level of omega fats equivalent to the amount they would have received naturally from their mothers had they been born at term.
‘We found that those babies fed DHA-rich milk had better visual development than those babies who were not,’ Lisa said.
While no differences in vision were found at two months of age, by four months babies who received the omega-3 supplements were able to see a finer pattern than the control group.
‘They were able to able to see a smaller striped pattern than the control group of babies.’
Lisa said she hoped her research findings would be used towards developing clinical guidelines in the future.
Mazda Helps Drive Parenting Program To Tackle Childhood Obesity
First Published: Investigator - October 2008
With childhood obesity rates on the rise, the Flinders Medical Centre Foundation successfully sought a $95,771 grant from the Mazda Foundation to see the Parenting, Eating and Activities for Child Health (PEACHTM) program made more widely available to families with overweight children.
PEACH was designed to help parents of overweight and obese children make healthy lifestyle changes by giving them the tools and support they need to make a long-term difference.
In 2002 the program was tested in one of Australia’s largest trials to determine the best way to treat childhood obesity.
Outcomes from the trial showed that a whole of family approach with parents driving lifestyle changes is the most effective and accepted strategy to help children lose weight.
“PEACH started in response to research that showed the number of overweight children had increased dramatically over the past 20 years,” said Dr Anthea Magarey, Senior Lecturer from the Department of Nutrition and Dietetics at Flinders University.
“Through trialling the program we discovered that it is imperative that community focused research and support occurs earlier rather than later if we are to have any chance of making long-term changes.”
PEACH will be held in a community group setting to teach parents how to deal with childhood obesity through a range of avenues, including how to increase activity and make lifestyle changes and introduce and maintain a healthy diet.
In the future it is expected that PEACH facilitators will also engage GPs, helping them to better identify overweight and obese children and give them a support program to refer families.
With the funds donated by the Mazda Foundation, Dr Magarey and her team have been able to start training more facilitators to expand the program further throughout South Australia.
Training is currently underway and Dr Magarey expects the first PEACH group to be held in early November 2008.
Driving The Fight Against Childhood Obesity
First Published: Investigator - September 2008
A weight management program is helping families battle the bulging waistlines of South Australia’s five to nine year old children.
The PEACH (Parenting, Eating and Activity for Child Health) program provides parents with the tools and support they need to create healthy diet and lifestyle changes. Group sessions with other parents are also offered as part of the program.
The program is led by Dr Anthea Magarey from the Department of Nutrition and Dietetics at Flinders University.
‘In Australia at least 20 percent of boys and girls aged between 2-17 years are obese,’ Anthea said. ‘Many parents see this as ‘puppy fat’, however a large number of children are not losing the excess weight as they grow older.’
‘Our program teaches parents how to learn strategies to introduce and maintain healthy diet and lifestyle changes in the family unit.’
The State Government has provided $200,000 over 2.5 years for the PEACH program. The Mazda Foundation has also donated $95,000 to make the program more widely available to families of overweight children.
The program aims to reach more than 1,000 parents of overweight children. For more information about PEACH call (08) 8204 6303.
Boost For Child Health Research
First Published: Investigator - February 2008
Researchers at Flinders Medical Centre will use the first machine of its kind in South Australia to diagnose and treat childhood diseases such as asthma and eye disease.
The $500,000 instrument is known as a Linear Ion Trap mass spectrometer and is the only one of its kind in South Australia. It is used in the study of proteins.
The mass spectrometer works by identifying proteins that are involved in the formation of disease. Once identified, these proteins are used to diagnose diseases or they are targeted in the treatment of a disease.
Researchers separate individual proteins and digest them with an enzyme to produce smaller fragments known as peptides. The mixture of peptides is then separated and analysed by the mass spectrometer.
The mass spectrometer fragments the peptides and measures the mass of these fragments. The data acquired by the mass spectrometer can be searched against large databases of proteins to identify the protein and the unknown disease.
Head of the Flinders Proteomic Facility Dr Tim Chataway said the mass spectrometer is a major addition to proteomic research at Flinders.
The mass spectrometer was funded through a $300,000 grant from Variety the Children’s Charity, the Child Health Research Institute and the FMC Foundation.
How does Bronchiolitis lead to Asthma?
First Published: Investigator - February 2007
How does infant Bronchiolitis caused by the Respiratory Syncytial Virus (RSV) lead to the development of asthma and persistent wheezing? Scientists at Flinders Medical Centre are attempting to unlock the answer to this question which has been of interest to researchers around the world for many years.
RSV Bronchiolitis is a very common illness usually contracted by infants during their first two years. It exhibits common cold like symptoms such as shortness of breath and coughing and in many infant cases the severity is such that hospitalisation is required.
Currently there is no specific treatment or vaccine for RSV Bronchiolitis. Those who develop this disease are generally cared for in a supportive manner similar to the treatment of a severe cold or flu with rest and oxygen supply if blood-oxygen levels drop too low.
“The natural course of this virus is normally only a week or two,” said Dr Dani-Louise Bryan, from the department of Critical Care Medicine. “However, there is a significant chance that children who contract RSV Bronchiolitis will go on to develop asthma or persistent wheezing.”
In past research Dr Bryan found an increase of a hormone like substance called prostaglandin (PGE2), which is triggered by the immune system to defend lung cells that have been exposed to the RSV virus by causing inflammation within the lung.
However, Dr Bryan has found that this defensive action can go too far, leading to the damage of healthy tissues and cells that aren’t infected. It is thought that this damage of healthy lung cells, to try and clear the virus, could be what leads to the development of asthma and persistent wheeze later in life.
“If the lungs are damaged when the patient is very young it seems that there is a predisposition to hyper-responsive lungs, causing breathing difficulties throughout their lives” said Dr Bryan. “With further investigation of PGE2 our team at Flinders hopes to pin point at what point this inflammatory response to RSV should be stopped.”
This research could lead to the development of a therapeutic agent that can modify the body’s responses to RSV where necessary and reduce healthy lung tissue damage.
Born To Hear
First Published: Investigator - September 2003
Nurses and doctors at Flinders are now able to detect hearing impairments in all newborns following the recent launch of the Variety Newborn Hearing Screening Program.
In South Australia approximately 25 infants per year are profoundly deaf and require either a hearing aid or cochlear implant to enable acquisition of speech and most infants remain undiagnosed until 18-24 months of age.
The new screening program tests newborns with a handheld Otoacoustic Emission (OAE) device. The non-invasive test is performed while the baby is asleep and around eight percent of healthy babies are expected to fail this test. However, approximately half of these babies will respond to a repeat test.
Babies who have not responded to initial testing and infants at a high risk of congenital deafness will undergo further testing using an Auditory Brainstem Evoked Response (ABR) machine. This detects and diagnoses problems in the inner ear and the hearing nerve responsible for transmission of information to the brain.
"Hearing impairments should be diagnosed and treated by the age of 6 months if the child is to develop normal speech. This new technology is the only way in which serious hearing impediments can be detected in time for early intervention" says Associate Professor Peter Marshall, Director of the Flinders Medical Centre’s Division of Women and Children,
Approximately 3,000 babies are born each year at Flinders.
The $80,000 screening program is possible thanks to funding for equipment from Variety the Children’s Charity, The Department of Human Services, The Australian Hotels Association SA, FMC Foundation Precious Possums, FMC Audiology and Flinders University Speech Pathology and Audiology.
Respiratory Syncytial Virus (RSV)
First Published: Investigator - April 2003
Respiratory Syncytial Virus (RSV) is the most common and dangerous virus in infants, effecting almost 100% of babies worldwide.
RSV lives inside the cells lining the respiratory system, causing swelling coupled with the production of large amounts of mucus.
Almost half of those infants affected by RSV will develop a severe chest infection commonly known as Bronchiolitis.
Bronchiolitis causes inflammation of the airways. It is not known what causes the inflammation. Without an understanding of this inflammation and how it occurs, it is not possible to develop effective treatments.
Professor Kevin Forsyth and his team in the Department of Paediatrics and Child Health at the Flinders Medical Centre have been investigating the mechanism of the disease process of RSV Bronchiolitis through a technique called Microarray Analysis, in an effort to create effective therapies.
Professor Forsyth explains, "When RSV infects the lungs, many cells release an array of substances known as cytokines. The Microarray Analysis allows the researchers to understand the response of thousands of genes expressed by these cells. Microarray analysis enable us to measure the response of thousands of genes which might be producing this lung inflammation.We are identifying which genes appear to be important in bronchiolitis. This will give us valuable clues in our search for understanding of the lung inflammation in bronchiolitis.
"The results obtained will lead us to identify several key substances important in the disease development of Bronchiolitis. If we can understand what happens then we can devise effective treatments. We are looking for a footprint if you like, to show us which genes are being switched on in this condition", said Professor Forsyth.
He added, "To date, our understanding on the range of these substances produced during acute bronchiolitis in children is limited. Lack of progess may have been caused by the difficulties in obtaining clinical material from babies and the lack of expertise and techniques. We now have access to fresh clinical material."
It is believed prevention of RSV bronchiolitis in babies will reduce the prevalence of childhood asthma in industrialised countries by 80%. With virtually 100% of newborn babies infected with RSV, this is welcome news.